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ERISA • Employment Law

Unum Ordered to Pay Wrongfully Denied Long-Term Disability Benefits to Fibromyalgia Patient

On September 21, 2018, the United States District Court for the District of Massachusetts issued an opinion awarding long-term disability (“LTD”) benefits to a fibromyalgia patient whose benefits were wrongly terminated by Unum Life Insurance Company and Provident Life and Accident Insurance Company, both of which are owned by Unum Group.  A copy of the Court’s decision in Kamerer v. Unum Life Ins. Co. of Am., et al., Case No. 15-cv-40146 (D. Mass. September 21, 2018), can be found here.  The plaintiff in the case is represented by long-time friends and friends of the firm, Talia Ravis (who was also a law school classmate of mine) and Jonathan Feigenbaum.

There’s a lot to unpack in the Kamerer decision, so I think it is probably best to read it yourself rather than restating the entire case at length in this post.  I will, however, provide a brief synopsis.  The plaintiff in Kamerer worked as a consultant for Accenture.  She became disabled in 2004 due to fibromyalgia and a number of related conditions that caused her constant pain.  She also struggled with depression.  She sought disability benefits under two different Unum LTD plans.  One plan was an employer-sponsored LTD plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). The other plan was an individual disability insurance policy (“IDI”).  Both plans contained a two-year limitation for disability benefits caused or contributed to by so-called “mental nervous” disorders.  Both LTD policies also required the plaintiff to be disabled from her “regular occupation” in order to receive benefits.

Unum approved the plaintiff’s claim and paid benefits without interruption under both policies from 2004 to 2013.  Unum did not assert the mental nervous limitation while her benefits were payable due to her fibromyalgia and related conditions.  In 2013, Unum decided she could return to her regular occupation.  Her treating physicians disagreed.  The plaintiff underwent a Unum-ordered “independent” medical exam (“IME”) that the Plaintiff contended in a sworn affidavit lasted approximately five minutes.  Her benefits were terminated in September 2014.  The plaintiff appealed internally with significant support from her treating health care providers that she was disabled, but Unum nonetheless denied her appeals.

The Plaintiff filed suit pursuant to Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), and state law in federal court.  The Court reviewed Unum’s decision de novo.  It noted that although Supreme Court precedent has held that the opinions of treating medical providers are not generally entitled special deference as a matter of law, when the participant’s credibility regarding subjective complaints of pain are at issue in the case, it makes sense to give more weight to the opinions of treating physicians who have personally assessed the participant over an insurer’s record reviewing consultants.  Moreover, the fact that the plaintiff had undergone extensive treatment for her condition and took numerous strong medications to treat her pain was strong evidence of her continued disability.  The Court disagreed with Unum’s assessment that there was no “objective evidence” of her continued disability because her physicians had repeatedly tested her for fibromyalgia via a trigger point test. Lastly, the Court rejected Unum’s attempt to assert the LTD plans’ respective mental nervous limitations after having failed to do so for years.  The Court noted that her physical limitations were the cause of her disability and that Unum had failed to factually prove otherwise.

This brief post does not really do the Kamerer plaintiff justice.  This decision is a great win for the plaintiff and others receiving LTD benefits due to fibromyalgia.

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Mr. Garner is an ERISA employee benefits and employment attorney with over a decade of experience. The laws governing employee benefits, the employment relationship, and the workplace are complex.

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